Agente Polivalente Elementar overcomes tragedy by helping her community

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Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) makes a check-up visit to three-year-old Beldencio who tested positive for malaria three days ago; in Jogo, Inhambane (Photo by Ruth Ayisi).

Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) as they are known in Mozambique, remembers how in the 1980s she lost three of her eight children to malaria. “There was no health centre nearby, no transport and no APE who could test and treat malaria.”

Today, Caterina, 46, supports her five surviving children, four of whom have gone on to further education. Not only has she been able to provide for her family by selling tangerines and avocados, but since 2010 she also has improved the health of her rural community in Jogo, in Mozambique’s southern province of Inhambane, after being elected by her community to work as an APE.

In 2012 Caterina attended a course supported by the Ministry of Health, in partnership with Malaria Consortium, to learn how to prevent, diagnose and treat malaria, diarrhoea and pneumonia, the three main killer diseases of children under the age of five in Mozambique.

Caterina’s working hours are from 9 am to 2 pm, Monday to Friday, which include consultations and home visits to carry out health promotion activities, including community dialogues around childhood illnesses, their prevention and management. “But sometimes when I return from my home visits I find mothers waiting for me,” says Caterina. “They also come during the night and over the weekends, and mothers from other communities who do not have an APE in their area also bring their children to me.”

Caterina works closely with the health committee, ensuring transparency and involvement of the community. “She always opens the monthly health kit [containing rapid diagnostic tests and medicines] in our presence,” says community leader Pedro Rafael. “We plan our health promotion activities together.” He adds, “Caterina has a lot of influence in our community. Before, most women used to give birth at home, but Caterina has sensitised them to make the journey to the health centre to give birth.”

Her supervisor, Hirondina Bernardo, a nurse at the health centre in Nhancoja, also speaks highly of Caterina and the other two APEs whom she supervises. “People who did not like coming to the hospital, now come when the APEs refer them, as the APEs are from their own communities and are trusted.” However, each month Caterina has to ride her bike for 18 kilometres along sandy tracks to collect supplies and deliver her record of consultations and health promotion activities. “The terrain is difficult”, comments nurse Hirondina, “so their bikes had to be replaced, and for a while some of the APEs had to walk each month to bring their records.” Despite the challenges, Caterina too says that she feels she makes a valuable contribution. “I keep the children in my community healthy,” she says.

Malaria Consortium is working with the Agente Polivalente Elementares in Inhambane through the inSCALE project. The inSCALE project is researching innovative ways to increase APE motivation and performance in order to increase the appropriate treatment of sick children. Since 2013, the APEs in six districts in Inhambane have been using smart phones with an application called inSCALE APE CommCare, which features a multimedia job aid with images and audio to guide APEs through the consultation steps, a closed user group enabling free communication between peers and supervisors, and a data submission tool that enables the APEs to submit their records over the 3G network. To learn more about the work of APEs such as Caterina and the inSCALE project please join us at INSTIDOC – Ciclo do Documentário Institucional on Friday 24th April 19h00 at Centro Cultural Franco-Moçambicano in Maputo, Mozambique to watch our documentary focusing on two APEs “Caterina e Halima”. For further details about the event, please visit the website: https://instidoc.wordpress.comor for more information about the inSCALE project: www.malariaconsortium.org/inscale/.

There are over 10 kilometres of sandy tracks from her house to the health centre of Nhacossa, where her supervisor is based. She alternates between cycling and walking and tries to rest a few times during the trip.

There are over 10 kilometres of sandy tracks from her house to the health centre of Nhacossa, where her supervisor is based. She alternates between cycling and walking and tries to rest a few times during the trip.